Morbilidad respiratoria en prematuros tardíos y término tempranos / Respiratory morbidity in late preterm and early term infant

INTRODUCCIÓN: Los Recién Nacidos prematuros tardíos (RNPTT) y los Recién Nacidos de Término Temprano (RNTt) son considerados una población de riesgo, con altos índices de ingreso hospitalario y morbimortalidad, mayor cantidad de días de internación y altas tasas de reingreso hospitalario en comparación a los Recién Nacidos de Término Tardío (RNTT). El Síndrome de distrés respiratorio es uno de los principales diagnósticos al ingreso, requiriendo distintos modos de soporte respiratorio, por lo tanto, requieren de cuidados especiales en unidades de media o alta complejidad, significando así un importante costo en salud. OBJETIVOS: Comparar la frecuencia en que se presenta la morbilidad respiratoria (MR) entre RNPTT y en RNTt Vs Recién Nacido a Termino Tardío (RNTT). Establecer factores asociados a MR. Describir los distintos modos de soporte respiratorio utilizados. PACIENTES Y MÉTODOS: Se incluyeron a todos los RNPTT (34 a 36 SEG), y RNTt (37 a 38 SEG) y se compararon con todos los pacientes RNTT (39 a 41 SEG) durante los años 2011 a 2015. Se excluyó a pacientes con malformación o síndrome genético, o derivados de otro centro médico. Análisis estadístico: La frecuencia de MR se consignó en porcentajes. La misma se comparó en ambos grupos utilizando la prueba de Chicuadrado y se realizó el cálculo de Odss Ratio. Las variables maternas o neonatales asociadas a MR se compararon entre los pacientes con o sin MR utilizando prueba U de Mann-Whitney para las variables continuas y Chi-cuadrado para variables categóricas. Las variables con un valor de P ≤ 0.1 en el análisis univariado se incluyeron en un modelo multivariado de regresión logística. El soporte terapéutico utilizado fue descripto en porcentajes y comparados mediante prueba de Chicuadrado y evaluados mediante odss ratio. RESULTADOS: Durante el periodo evaluado se analizaron los datos de 10512 pacientes de los cuales 766 (7,8%) fueron RNPTT, 3654 (92,6%) RNTt y 6087 (57,90%) RNTT. La frecuencia de MR en los RNPTT fue de 202 (26,4%), en los RNTt fue de 115 (3,15%) Vs 46 (0,76%) en los RNTT. El Odss ratio para MR entre RNPTT y RNTt comparado con RNTT respectivamente fue: OR 47.03, IC95% 33.7 a 65.53, P 0.0001, OR 4.26, IC95% 3.02 a 6.02, P 0.0001. (Siendo los RNTT el grupo control. Ver tabla). En el análisis multivariado se observaron factores de riesgo asociados a MR: Patología asociada al embarazo (OR 4,248, IC95% 2,918 a 6,184, P 0.0001), el Apgar menor a 7 a los 5 min (OR 15,09, IC95% 4,64 a 49,03, P 0.0001), el nacimiento por cesárea (OR 2,96 IC95% 2,32 a 3,78, P 0.0001), sexo masculino (OR 1,5 IC95% 1,21 a 2,01, 0,001). En la evaluación en toda la población general se observó al Retardo de Crecimiento Intrauterino (RCIU) como factor protector de MR, (OR 0.51, IC95% 0,29 a 0,92, P 0.029). Los datos en relación al soporte de oxígeno se muestran en la Tabla1. CONCLUSION: Los recién nacidos prematuros tardíos y los recién nacido termino temprano presentaron mayor morbilidad respiratoria comparado con los recién nacidos termino tardío. Los factores de riesgo más preponderantes para MR fueron la prematurez, el nacimiento por cesárea, nacer con Apgar menor a 7 a los 5 min y la existencia de patología materna asociada al embarazo. Los RNPTT y RNTT son una población de riesgo (mayor requerimiento de internación, más días de internación, mayor morbilidad respiratoria y mayor soporte de oxigeno), por lo que se deben de adoptar medidas preventivas para lograr disminuir los factores de riesgo que generan el nacimiento prematuro tardío y término temprano y así lograr disminuir los índices de morbi mortalidad y costos en salud que estos implican. (AU)

INTRODUCTION: Late Preterm Newborns (LPN) and Early Term newborns (ETN) are considered to be at risk, because they have high rates of hospital admission, morbidity and mortality, more days of hospitalization, and high rates of hospital readmission compared To Late term Newborns (LTN). Respiratory distress syndrome is one of the major diagnoses on admission, requiring different modes of respiratory support, therefore, require special care in medium or high complexity neonatal units, meaning a significant health cost. OBJETIVES: Compare the frequency of respiratory morbidity (RM) between late preterm and early term infants Vs complete or late term newborns. Establish factors associated with RM. Describe the different modes of oxigen respiratory support used. PATIENTS AND METHODS: All LPN (34-36 SEGs) and ETN (37-38 SEGs) were included and compared to all LTN (39-41 SEGs) during the years 2011 to 2015. Were excluded patients With malformation or genetic syndrome, or derived from another medical center. Statistical analysis: The frequency of RM was recorded in percentages. The same was compared in both groups using the Chi-square test and the Odss Ratio calculation was performed. Maternal or neonatal variables associated with RM were compared between patients with or without RM using Mann-Whitney U test for continuous variables and Chisquare for categorical variables. Variables with a value of P ≤ 0.1 in the univariate analysis were included in a multivariate logistic regression model. The therapeutic support used was described in percentages and compared by chi-square test and evaluated by odss ratio. RESULTS: Data from 10512 patients were analyzed in the evaluation periode, of which 766 (7.8%) were LPN, 3654 (92.6%) ETN and 6087 (57.90%) LTN. The frequency of RM in the LPN was 202 (26.4%), in the ETN it was 115 (3.15%) vs 46 (0.76%) in the LTN, the odss ratio for RM comparing LPN and ETN with LTN respectively was: OR 47.03, 95% CI 33.7 to 65.53, P 0.0001, OR 4.26, IC95% 3.02 to 6.02, P 0.0001 (LTN being the control group. See table). In the multivariate analysis it was observed the risk factors asociated with RM: the pathology associated with pregnancy (OR 4.248, 95% CI 2.918 to 6.184, P 0.0001), Apgar less than 7 at 5 min (OR 15.09, 95% CI 4.64 to 49.03, P 0.0001). Cesarean birth (OR 2.96, IC95% 2.32 a 3.78, P 0.0001) and Male sex (OR 1,5 IC95% 1,21 a 2,01 P 0,001). In the evaluation in the general population, the Intrauterine Growth Retardation (IUGR) was observed as a protective factor of MR, (OR 0.51, 95% CI 0.29 to 0.92, P 0.029). The data in relation to the oxygen support are shown in Table 1. CONCLUSION: Late preterm infants and early term infants presented higher respiratory morbidity compared to late term newborns. The most important risk factors for RM were prematurity, cesarean birth, birth with Apgar less than 7 at 5 minutes and the existence of maternal pathology associated with pregnancy. The LPN and ETN are a population at risk (greater requirement of hospitalization, more days of hospitalization, greater respiratory morbidity and greater support of oxygen), so that preventive actions must be taken to reduce the risk factors who give late preterm and early term birth and thus reduce morbidity rates and health costs that these imply. (AU)

Elimination of a pressure ulcer with electrical stimulation--a case study

Pressure ulcers, also called decubitus ulcers, are a common challenge of humanity and are exceptionally difficult to heal. They are wounds that are initiated by relatively short periods of pressure on the skin that blocks blood circulation causing the skin and underlying tissues to die, leading to an open wound. Pressure release can prevent further tissue degeneration, and some ulcers heal and disappear by themselves. However, many pressure ulcers never heal and continue to grow in diameter and depth. By one year, such unhealing ulcers are referred to as chronic ulcers. Chronic ulcers frequently jeopardize the life of the patient due to infections that become increasingly deep until they invade bones and the circulatory system. We report on a patient with a chronic pressure ulcer at his coccyx prominence. Fourteen months after the ulcer had appeared, a surface pulse electromagnetic force (PEMF) stimulator was applied over T7-T8, 45 cm cephalic to the ulcer, as part of a nerve stimulation study. Although the ulcer had continued to grow both in diameter and depth for 14 months and showed no signs of healing, within 6 days of applying the PEMF stimulator, the ulcer began to heal and was fully eliminated after 3 months. We concluded that the electrical stimulation induced the healing of the pressure ulcer. The ulcer elimination is quite surprising due to the exceptionally low electric field-force being generated by the stimulator at a distance of 45 cm.

A novel technique leading to complete sensory and motor recovery across a long peripheral nerve gap

Sensory nerve grafts are the [quot ]gold standard[quot ] for inducing neurological recovery in peripheral nerves with a gap. However, the effectiveness of sensory nerve grafts is variable, generally not leading to complete sensory and motor recovery, with good recovery limited to gaps shorter than 2 cm, and the extent of recovery decreasing with increasing graft length. An alternative technique using a conduit filled with pure fibrin to bridge a nerve gap leads to only limited neurological recovery. We tested the effectiveness of a novel nerve repair technique in which a 5-cm long radial nerve gap was repaired using two sural nerve graft surrounded by a collage tube filled with pure fibrin. By 1 1/2 years post surgery, the patient recovered complete sensory and motor function. In conclusion, this study suggests that the combination of pure fibrin surrounding sural nerve grafts is responsible for inducing the extensive neurological recovery induced by either pure fibrin or sural grafts alone. This technique is presently being tested in a clinical trial.

Morphological characterization of six subpopulations of adult human DRG neurons at the light microscopic level

Dorsal root ganglion (DRG) neurons are composed of physiologically distinct subpopulations, each responding to a different sensory stimulus. One can morphologically discriminate between two broad populations of adult rat and frog DRG neurons by their appearance under the light microscope. These groups are called large clear and small dark. However, additional subpopulations have not been identified by visual observation. Such identification requires application of immunochemistry or biophysical techniques. Although these are useful techniques, they do not allow the rapid discrimination of different neuron subpopulations, which would be useful for pharmacological studies on unique neuron subpopulations. Such experiments would be greatly facilitated if viable DRG neuron subpopulations could be identified based on their morphology at the light microscopic level. Just as for adult frog and rat DRG neurons, when adult human DRG neurons are observed under phase optics, two subpopulations can be seen, small dark and large light. However, under bright-field illumination, six distinct subpopulations can be distinguished based solely on morphological features. Five subpopulations contain rusty-colored cytoplasmic inclusions with different sized granules and differences in the size and density of the granule clusters, while one is granule-free. Analysis of the soma diameter distribution shows each of the six granule-containing and the non-granule-containing (clear) neuron subpopulations has a statistically significant difference in size distribution. We propose that neurons with different morphologies correspond to unique physiological subpopulations of DRG neurons. Experiments are underway using immunochemical techniques to determine whether neurons with the unique morphologies correspond with unique physiological functions.

Neuroprotection of adult human neurons against ischemia by hypothermia and alkalinization

Ischemia of intact dorsal root ganglia (DRG) in situ leads to massive neuron death due to ischemia-triggered secondary events, such as massive release of excitatory amino acids from the neurons, their excessive accumulation and activation of neuron NMDA and other receptors, acidification, and loss of calcium homeostasis. The present experiments tested whether hypothermia and alkalinization, separately or combined, provide neuroprotection against 1-4 hours of ischemia to the neurons within intact DRG acutely removed from organ donors. DRG under hypothermic (20-15 degrees C) or alkaline (pH 8.0-9.3) conditions yielded more viable neurons than DRG maintained under physiological conditions (37 degrees C/pH 7.4), 4.1-fold vs. 7.8-fold respectively, but, hypothermia and alkalinization combined (20 degrees C/pH 9.3) increased the yield of viable neurons 26-fold compared to DRG maintained under physiological conditions. These results show that combined hypothermia and alkalinization provide adult human DRG neurons significant neuroprotection against ischemia, and ischemia-induced causes of neuron death.

Hepatitis B immune status of non-injecting drugusers 18- to 25-years-old in Puerto Rico.

INTRODUCTION: Ilicit drug users are the population group at highest risk of HBV infection in most Western countries. In this study we assessed hepatitis B virus (HBV) immune status in a cohort of young non-injecting drug users in Puerto Rico. METHODS: Subjects were eligible if they were 18- to 25-years-old, had never injected any drugs, and had recently used heroin or cocaine. A total of 541 subjects were recruited from community settings during 2004 and 2005. Subjects were interviewed and tested for HBV immune status and infection. RESULTS: Overall, 36.6% showed evidence of HBV immunity. Among subjects not HBV immune, 63.0% reported being vaccinated against HBV. Rates of HBV immunity were 47.6% among subjects who were 12-years-old or less in 1995 when mandatory school verification of HBV vaccination was established and 23.0% among those who were older than 12 in 1995 (p<.001). HBV immunity was 52.5% among non intravenous drug user who were 12-years-old or less in 1995 if they had not dropped out of school before the 8th grade compared to 23.9% (p<.001) among those who did drop out before the 8th grade. CONCLUSIONS: Mandatory school verification of HBV vaccination seems to have had a substantial effect in increasing coverage among young illicit drug users. However, the impact of mandatory school verification appears to be limited by the fact that many illicit drug users drop out of school early after completing the primary level.

Advances in spinal cord repair techniques

Daily US accidents result annually in over 20,000 cases of traumatic spinal cord injury associated with complete and permanent paraplegias and quadriplegias frequently associated chronic pain. This amounts to new annual health care a costs of dollar 3.2 billion, and a total annual cost for all such individuals in the US of dollar 96 billion. Tens of thousands of additional people suffer lesser degrees of permanent debilitating lost spinal cord function. To help these people recover neurological functions, and simultaneously reduce the enormous suffering, and the associated medical expenses, requires developing techniques that induce the regeneration of lesioned adult human spinal cord axons. A number of techniques lead to varying degrees of axon regeneration and neurological recovery in the rat, but the recovery is invariably limited. While other approaches show potential, they have not led reliable neurological recovery. Most spinal cord repair techniques cannot be applied clinically because they require materials that are not FDA-approved. However, several FDA-approved materials are available that hold great promise for inducing axon regeneration, especially when used simultaneously. Here we review efforts to induce the regeneration of spinal cord axons, how what is known about promoting regeneration of axons across peripheral nerve gaps may be applied to repairing spinal cord lesions, and finally, how several readily available materials may induce axons to regenerate in the spinal cord and restore neurological function.

Promoting neurological recovery following a traumatic peripheral nerve injury

If a peripheral nerve is crushed, or if the nerve is cut and the ends sutured together soon after the lesion (anastomosed), neurological recovery is good. When a length of a peripheral nerve is destroyed, and anastomosis is not possible, the standard surgical repair technique is to graft a length/s of sensory nerve from the patient, into the gap. For gaps 4 cm recovery is limited to non-existent. The limited recovery is because sensory nerves act as passive scaffolds for axon regeneration and do not actively promote axon regeneration. However, such grafts remain the [quot ]gold standard[quot ] for nerve repairs. New techniques are required that induce improved neurological recovery. This paper reviews current clinical and basic research techniques for inducing neurological recovery following traumatic peripheral nerve injuries.

Immunosuppressants: neuroprotection and promoting neurological recovery following peripheral nerve and spinal cord lesions.

No clinical techniques induce restoration of neurological losses following spinal cord trauma. Peripheral nerve damage also leads to permanent neurological deficits, but neurological recovery can be relatively good, especially if the ends of a transected nerve are anastomosed soon after the injury. The time until recovery generally depends on the distance the axons must regenerate to their targets. Neurological recovery following the destruction of a length of a peripheral nerve requires a graft to bridge the gap that is permissive to, and promotes, axon regeneration. But neurological recovery is slow and limited, especially for gaps longer than 1.5 cm, even using autologous peripheral nerve grafts. Without a reliable means of bridging long nerve gaps, such injuries commonly result in amputations. Promoting extensive neurological recovery requires techniques that simultaneously provide protection to injured neurons and increase the numbers of neurons that extend axons, while inducing more rapid and extensive axon regeneration across long nerve gaps. Although conduits filled with various materials enhance axon regeneration across short nerve gaps, pure sensory nerve graft remains the gold standard for use across long nerve gaps, even though they lead to only limited neurological recovery. Consistent results demonstrate that several immunosuppressive agents enhance the number of axons and the rate at which they regenerate. This review examines the roles played by immunosuppressants, especially FK506, with primary focus on its role as a neuroprotectant and neurotrophic agent, and its potential clinical use to promote improved neurological recovery following peripheral nerve and spinal cord injuries.

Evaluation of the sorption properties of a Mexican organo clinoptilolite-rich tuff for phenol and 4-chlorophenol.

A Mexican clinoptilolite-rich tuff was modified with the hexadecyltrimethyl ammonium (HDTMA) and used for the sorption of phenol and 4-chlorophenol. Whereas the zeolitic tuff had no affinity for phenol and 4-chlorophenol, the modified zeolite removed these organic compounds. The sorption behavior from aqueous solutions was studied by means of batch type and column experiments and isotherms were determined. It was found that the uptake was higher for 4-chlorophenol than for phenol.

Neuroprotection of spinal neurons against blunt trauma and ischemia

Each year in the Unites States there are over 10,000 new cases of para- and quadriplegia, and more than 100,000 cases of limited, but permanent, neurological losses. Many of these losses result from blunt trauma and ischemia to the spinal cord which leads to neuron death. Although blunt trauma directly kills neurons due to the physical trauma, over the subsequent 48 hours an even larger population of neurons dies due to secondary causes. One of leading triggers of this neuron death is ischemia due to the disruption of the blood circulation. Selective, but unavoidable, spinal cord ischemia occurs during thoracoabdominal surgery to repair aortic aneurysms. This ischemia leads to neuron death, functional neurological loss, and paraplegia in up to 33 per cent of the cases. Thus, both blunt trauma and induced ischemia have similar triggers of neuron death. To reduce the neurological losses resulting from ischemia mechanisms must be found to make spinal neurons more tolerant to ischemic insult and other secondary causes of neuron death. In this review we discuss mechanisms being developed, predominantly using animal models, to provide neuroprotection to prevent neurological losses following blunt trauma and during induced spinal cord ischemia. In parallel, our own experiments are looking at neuroprotective techniques using adult human neurons. We believe the optimal neuroprotective approach will involve the perfusion of the ischemic region of the spinal cord with a hypothermia solution containing a combination of pharmacological agents.

Manifestaciones bucales e infecciones oportunistas mas frecuentes encontradas en 208 pacientes con infección por VIH/SIDA / Most frequent oral manifestations and oportunistic infections found in 208 patients with HIV/AIDS infection

La historia natural de la infección por VIH/SIDA ha sido descrita como un deterioro insidioso y progresivo del sistema inmune; generalmente esto se acompaña con el reconocimiento de algunas manifestaciones bucales; las mismas son de gran importancia porque podrÝan representar el primer signo de esta enfermedad. El propósito de este estudio fue determinar los tipos y la prevalencia de lesiones bucales asociadas a la infección por VIH/SIDA y la prevalencia de infecciones oportunistas. MÚtodos: este es un estudio descriptivo, transversal, preliminar y exploratorio que incluye un grupo de pacientes con evidencia serológica de infecicón por VIH/SIDA, los cuales fueron examinados durante el perÝodo comprendido entre los meses de noviembre de 1998 y julio del 2000. Resultados: dentro de este grupo de pacientes, 108 (66 por ciento) presentaron lesiones bucales. Las mßs comunes fueron: candidasis (48.7 por ciento), leucoplasia vellosa (12.3 por ciento), herpes labial (11.7 por ciento), otras lesiones bucales fueron: leucoplasia (6.5 por ciento), hiperpigmentación melßnica (4.5 por ciento). Las enfermedades infecciosas oportunistas mßs frecuentes fueron la hepatitis (14.9 por ciento), neumonÝa por pneumocistis carinii (11.5 por ciento), infección por el virus del herpes zoster (8.6 por ciento) y toxoplasmosis (8.6 por ciento). Conclusión: los pacientes con infeccion por VIH/SIDA presentan un amplio espectro de manifestaciones bucales e infecciones oportunistas, por lo tanto el reconocimiento, diagnóstico, manejo y tratamiento adecuado son importantes para el mejoramiento de la calidad de vida de estos individuos

[Microbial etiology of mild and moderate pelvic inflammatory disease]. / Etiología microbiana de la enfermedad inflamatoria pélvica leve y moderada (EIP).

Pelvic inflammatory disease (PID) is one of the most severe complications of sexually transmitted disease (STD). It can be due to the ascending of normal endogenous microorganisms of the female genital tract or the infection by microorganisms related to STD as Chlamydia trachomatis and Neisseria gonorrhoeae. PID leads to serious gynecoobstetric consequences as infertility and ectopic pregnancy. Clinicians face the problem of knowing the ethiology of PID in order to treat appropriatly patients with this clinical diagnosis. So that, this work pretends to establish what kind of microorganisms are implicated in PID. A proper isolation and identification of microorganisms achieved by culture of lower genital tract samples from endocervix, endometrium and peritoneal fluid, leading to a betther, specific and proper treatment of this disease.

Sinus histiocytosis with massive lymphadenopathy (Rosai-Dorfman disease) and extranodal involvement of the orbit.

We present the case of a 5-year-old boy who was referred to the Neurosurgical Service of the San Jorge Children's Hospital for evaluation of right eye proptosis. At the age of one year the diagnosis of sinus histiocytosis with massive lymphadenopathy (SHML) had been rendered on a cervical lymph node biopsy. The right orbit mass causing the proptosis was the result of extranodal involvement of the orbital tissue by SHML. The clinical and pathologic features of this entity are discussed.

Streptococcus pyogenes en escolares de diferentes zonas de la Ciudad de Mexico / Streptococcus pyogenes carriers among school children in different areas of mexico city

Se trata de un estudio que tiene por objeto conocer la frecuencia de portadores de streptococcus pyogenes en una muestra de escolares de la ciudad de Mexico los escolares se captaron de tres escuelas ubicadas en diferente zonas y con diferentes niveles socioeconomicos. se les aplico un cuestionario para conocer aspectos epidemiologicos, además se les tomó exudado faringio se estudiaron 402 escolares y se encontraron 62 portadores (15.42%); La mayor frecuencia correspondio al grupo de 8 a 9 años (35.4%). Al relacionar el grupo de positivos con hacinamiento y calidad de la vivienda, se observó que el número de portadores aumentaba cuando la calidad de la vivienda era mala y el hacinamiento alto.